Factors influencing accuracy of axillary sentinel lymph node frozen section for breast cancer

• Published in: The American journal of surgery Vol. 199; no. 5; pp. 629 - 635
• Main Authors: Jensen, Amariek J., B.S, Naik, Arpana M., M.D, Pommier, Rodney F., M.D, Vetto, John T., M.D, Troxell, Megan L., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2010; Elsevier Limited
• Subjects: Accuracy; Aged; Axilla; Axillary lymph node dissection; Biopsy; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer; Cohort Studies; Databases, Factual; Dissection; False Negative Reactions; Female; Follow-Up Studies; Frozen section; Frozen Sections - methods; Histopathology; Humans; Immunohistochemistry; Intraoperative Care - methods; Invasiveness; Lymph; Lymph Node Excision - methods; Lymph nodes; Lymph Nodes - pathology; Lymphatic system; Mastectomy - methods; Metastases; Metastasis; Micrometastasis; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Patients; Probability; Retrospective Studies; Review boards; Risk Assessment; Sensitivity and Specificity; Sentinel lymph node; Sentinel Lymph Node Biopsy - methods; Surgery; Survival Rate; Tumor cells; Micrometastasis; Breast cancer; Axillary lymph node dissection; Sentinel lymph node; Frozen section
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.01.017

Abstract Background Intraoperative sentinel lymph node (SLN) frozen section (FS) guides immediate axillary lymph node dissection in breast cancer patients. Methods The Oregon Health & Science University pathology database was searched for SLN FS From October 1999 to January 1, 2009. Slides of positive cases were reviewed and metastasis sizes measured. Results Of 416 cases, 129 were positive (31%) on permanent sections and immunohistochemistry, with 79 concordant and 50 false-negative FS. Accuracy was 88%, sensitivity 61%, and specificity 100%. FS accuracy for lobular carcinoma (76%) was lower than for invasive ductal carcinoma (88%) ( P = .048). FS accuracy significantly differed by size of nodal tumor. For 49 cases of tumor ≤ 2 mm (isolated tumor cells plus micrometastases), the accuracy of FS was 18%; for 77 cases of >2-mm metastases, accuracy was 90% ( P < .0001). Conclusions False-negative FS were predominantly small nodal tumor deposits not sampled at FS. Although accuracy was lower, SLN FS is still beneficial in lobular carcinoma, but not ductal carcinoma in situ.